Thursday, October 16, 2008

New Initiative Will Teach Faculty the Differences Between CME and Promotion

I realize this headline sounds farcical, like something you'd read in the Onion (“Bush Calls for Panic”) but in fact it was on the first page of the October newsletter from the Alliance for CME, a CME trade group. Yes, the MECC industry has finally admitted that the difference between industry-funded CME and drug promotion is very difficult to puzzle out. So, in concert with Pfizer and Audio Digest, they are creating a 45 minute internet course to teach hired guns how to thread this perplexing needle.

According to the article: “Medical education faculty who complete the 45 minute online activity will have their names added to the National Faculty Education Initiative verification database.” That’s a sentence-full. Basically, take the course and you get to advertise yourself to MECCs looking to hire speakers to promote their clients’ drugs. Did I say "promote"? I meant educate about their sponsors' drugs. Wait—what I really meant was educate about a topic area in which the sponsor has a commercial interest. Oh darn, I’m still confusing CME with promotion. Obviously, I need that course.

The outraged trade group wrote that “The article’s assertion that continuing medical education (CME) has become “one of the most profitable businesses” for “marketing firms” falsely equates independent, certified CME with pharmaceutical marketing and promotion.”

But given this most recent educational initiative, I think that NAAMECC owes Arlene Weintraub, the article’s writer, an apology. If the faculty who specialize in teaching CME need a custom-designed course to divine how industry CME is not promotion, it’s hardly fair to rake a journalist over the coals for having "confused" the two.

4 comments:

We were having training sessions for faculty [speakers] back in 2002. The sad thing was that you could explain at length what the differences were between the two kinds of activities, and a speaker would be bent out of shape that their rep couldn't be there to 'support' them during a CME event.

Every once in a while, I come across something in the literature that thankfully supports my concerns and positions about the worsening state of psychiatry. For those who have followed my comments here and at other mental health blog sites since the year began, you know how I feel about the role of managed care in ruining this field. I will just advise you to read Glenn Treisman's current Viewpoint column in American Psychiatry News (www.americanpsychiatrynews.com), but I will quote his last two paragraphs to reinforce his point:

"The New England Journal of Medicine, The Journal of the American Medical Association, and The American Journal of Medicine, as well as many others, have been consumed with articles on conflicts of interest with pharmaceutical companies and their profits. I would reply that pharmaceutical companies make money! They profit on medications that people take to get better. There is not a single reference in any major journal on PubMed for ERISA [Employee Retirement Income Security Act, that shields managed care from legitimate lawsuits in their refusing care that Dr Treisman illustrates earlier in the article]. The only review I could find-other than the law journals, of course, which discuss this issue often-is in the March 1999 issue of Psychiatric Clinics of North America. Where is the backlash against restrictive utilization review decreasing the quality of care and driving up the cost through disability, liability,and lost productivity and quality of life?It is critical that we examine the cost of failed medical care when we talk about medical care costs. The cost of actual care is increasingly eclipsed by the cost of utilization reviewers, managers, policy makers, lawyers, lobbyists, and the drain on my time trying to defend what the patient needs. IT IS TIME FOR THIS LAW TO CHANGE [my highlight here]."

Amen to that last statement. Psychiatrists shot themselves in the foot not fighting this beast 15-20 years ago, and this is the legacy left for ourselves in bargaining/relinquishing to this evil. We are, as a wise doctor wrote in a letter to the editor in a journal a year or two ago, just hydraulic lift operators. We just raise and lower medications like machinists.

It is menial labor, no offense to those who have skills in such industry jobs, but that is not what is expected of a psychiatrist. So, bitch about pharma, colleagues like Nemeroff or Schatzberg, or phony CME programs, but in the end, we've lost focus.

And, like Dr Treisman says, why isn't anyone writing about managed care's erosion of care? Why, are we history, just still in the making?

Have you tried this training? I decided to take it after seeing this blog. It's pretty sad. First, there is no disclosure of any commercial funding that I can find. Second, it's a superficial review of as you have described, an incredibly complex and misunderstood area. And third, it's not reality-based. There is an example of peer review and conflict management describes a CME activity that is sponsored by a medical society, funded by a company, and operated by a "third party" MECC. The speaker sends in his presentation slides to the society (huh..in the real world the speaker sends his slides to the MECC). His slides are sent back to him edited, to tone DOWN his comments on the funders product (what? when, in the real world, has that ever happened? In the real world, the MECC sends the slides to its client, and edits the material to be "on message"). And in the real world, changing someone's slides is not going to manage the conflict, nor change what he says on the podium.

There needs to be a real training to help people to be able to identify what is promotional and what is independent.